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NPI Code Detail

MEDICARE: DR STEPHEN R. HENRY, DDS PC

MEDICARE: DR STEPHEN R. HENRY, DDS PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist16538MI

General Provider Information

NPI Number : 1134491103
Entity Type Code : Organization
Provider Name (Legal Business Name) : DR STEPHEN R. HENRY, DDS PC
Provider Business Mailing Address
First Line : PO BOX 660
Second Line :
City : WASHINGTON TWP
State : MI
Zip : 48094-0660
Country : US
Telephone Number : 586-781-6700
Fax Number : 586-781-6819
Provider Business Practice Location Address
First Line : 57911 VAN DYKE RD
Second Line : SUITE B
City : WASHINGTON TWP
State : MI
Zip : 48094-2763
Country : US
Telephone Number : 586-781-6700
Fax Number : 586-781-6819
Authorized Official
Title or Position : DENTIST
Name : DR. STEPHEN R HENRY
Credential : DDS
Telephone Number : 586-781-6700
Provider Enumeration Date : 02/06/2012
Last Update Date : 02/06/2012

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